SSC-HR-Former Employees Data Request

Please complete this eForm and upload a signed authorization form as well as any other forms needing completion, if applicable. If submitting a Public Service Loan Forgiveness (PSLF) request, please upload a completed and signed Page 1 of the PSLF form. A separate signed authorization is not required if submitting a signed PSLF Page 1.

Per policy, the SSC is unable to provide:

*Specific information on academic appointments
*U-M student verifications
*Creditworthiness
*Evaluation questions
*Credentialing/Privileging Requests for Medical Staff
*Visa/Travel letters
*Verification of future employment not available in Wolverine Access
*Continuation of employment or future earnings
*Specific job descriptions or duties
*Reason for leaving or rehire status
*Information for University relationships that are: Affiliated, Sponsored Non-Employee Taxable Services, or PeoplePay

University of Michigan Employee First Name

University of Michigan Employee Last Name

Phone Number

Email

If known, please list the employee's eight digit University of Michigan ID number.

University of Michigan Employee - Full SSN

Were you employed prior to 2001?

Employee Report Sample

https://ssc.umich.edu/wp-content/uploads/sites/...

Please select the employment verification below that suits your need.

Employment Report (hire date, termination date, title, hours, salary, pay frequency, gross earnings)

Public Service Loan Forgiveness (PSLF) Certification and/or Application

Other

Please Note - Regarding PSLF submissions:

For questions regarding qualifying for the Public Service Loan Forgiveness program, please visit University Human Resources:
https://hr.umich.edu/about-uhr/uhr-news/dealing...

The Shared Services Center cannot comment on qualifying for the PSLF program.

Please provide more details for your VOE request.

Requested Information

Hire Date

Termination Date (if applicable)

Current and/or Final Job Title(s)

Specific Job Title(s) and/or Specific Date(s)

Full Employment History

Standard Hours & Full-time vs. part-time

Salary/Hourly Rate

Pay Frequency (biweekly or monthly)

Gross earnings from ________ to _______

Gross earnings start date

Gross earnings end date

Attachment

*Authorization
*Form

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Description

The full details of a ticket, including any appropriate circumstances or supplementary information that may aid in resolving it.

Please allow up to five business days for processing your request. We appreciate your patience.

Your name

Your email address

Your phone number

Verification Code

SSC-HR-Former Employees Data Request

Per policy, the SSC is unable to provide:

Other Fields